Title
Early Recognition of Low-Risk SARS-CoV-2 Pneumonia: A Model Validated With Initial Data and Infectious Diseases Society of America/American Thoracic Society Minor Criteria
Date Issued
01 October 2022
Access level
open access
Resource Type
research article
Author(s)
Menéndez R.
Méndez R.
González-Jiménez P.
Zalacain R.
Ruiz L.A.
Serrano L.
España P.P.
Uranga A.
Pérez-de-Llano L.
Golpe R.
Torres A.
Publisher(s)
Elsevier Inc.
Abstract
Background: A shortage of beds in ICUs and conventional wards during the COVID-19 pandemic led to a collapse of health care resources. Research Question: Can admission data and minor criteria by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) help identify patients with low-risk SARS-CoV-2 pneumonia? Study Design and Methods: This multicenter cohort study included 1,274 patients in a derivation cohort and 830 (first wave) and 754 (second wave) patients in two validation cohorts. A multinomial regression analysis was performed on the derivation cohort to compare the following patients: those admitted to the ward (assessed as low risk); those admitted to the ICU directly; those transferred to the ICU after general ward admission; and those who died. A regression analysis identified independent factors for low-risk pneumonia. The model was subsequently validated. Results: In the derivation cohort, similarities existed among those either directly admitted or transferred to the ICU and those who died. These patients could, therefore, be merged into one group. Five independently associated factors were identified as being predictors of low risk (not dying and/or requiring ICU admission) (ORs, with 95% CIs): peripheral blood oxygen saturation/FIO2 > 450 (0.233; 0.149-0.364); < 3 IDSA/ATS minor criteria (0.231; 0.146-0.365); lymphocyte count > 723 cells/mL (0.539; 0.360-0.806); urea level < 40 mg/dL (0.651; 0.426-0.996); and C-reactive protein level < 60 mg/L (0.454; 0.285-0.724). The areas under the curve were 0.802 (0.769-0.835) in the derivation cohort, and 0.779 (0.742-0.816) and 0.801 (0.757-0.845) for the validation cohorts (first and second waves, respectively). Interpretation: Initial biochemical findings and the application of < 3 IDSA/ATS minor criteria make early identification of low-risk SARS-CoV-2 pneumonia (approximately 80% of hospitalized patients) feasible. This scenario could facilitate and streamline health care resource allocation for patients with COVID-19.
Start page
768
End page
781
Volume
162
Issue
4
Language
English
OCDE Knowledge area
Sistema respiratorio
Scopus EID
2-s2.0-85138643387
PubMed ID
Source
Chest
ISSN of the container
00123692
Sources of information: Directorio de Producción Científica Scopus